Confirmation and Signature Sample Clauses

Confirmation and Signature read and agree to abide by the CMCSS Volunteer Code of Ethics (SAF-F028) I further understand that as a volunteer, if I will not be alone with a student unless required and within view of school personnel. If I participate in a school-sanctioned overnight trip, I must provide a copy of my driver’s license and be cleared in a background check through the TBI Sex Offender Registry.
Sample 1
AutoNDA by SimpleDocs
Confirmation and Signature. I confirm that I have read and that I am bound by the terms and conditions of this Original Account Agreement in connection with my purchase of Shares in the Fund. I acknowledge that the current Prospectus, relevant Supplement, and the latest annual or semi- annual report of the Fund, as well as the current KIID for the relevant Share Class that I intend to subscribe for, shall be the sole basis for purchasing Shares. No other information or representations may be relied upon. Further copies of the Prospectus may be obtained from the Fund or from Insight Capital B.V., at their respective addresses. Copies of the most recent annual report and any subsequent semi-annual report of the Fund are available free of charge on request. The KIIDs are available at xxx.xxxxxxxxxxxxxx.xx/xxxxx The Application Form must be signed by each applicant. In the case of applications by partnerships, proprietorships or other unincorporated associations or firms, the applications should be signed by all the partners/proprietors. In the case of applications by corporations, applications should be executed under seal or signed by a duly authorised person(s) who should indicate their representative capacity. In the case of trusts, applications should be made in the individual names of the trustees and should be accompanied by duly certified documentation. If this application form is signed under power of attorney, such power of attorney or a duly certified copy thereof must accompany this application. First Applicant: Name of the Applicant Address Capacity of Authorised Signatory Date (dd/mm/yyyy) Signature Joint Applicants: Name Signature Name Signature Name Signature Date (dd/mm/yyyy) TAX CLASSIFICATION AND TAX RESIDENCY FORM The information requested in this section is being collected for the purposes of tax reporting obligations imposed on the Fund pursuant to FATCA and the OECD Common Reporting Standard (the “CRS”). This information collected by the Fund will be reported to the Dutch Revenue Commissioners. In turn, the Dutch Revenue Commissioners will exchange the information collected from each Applicant with the tax authority of their country of residence, where that country has implemented the CRS regime, or with the Inland Revenue Service of the United States where that person is a US Reportable Person for FATCA purposes. Applicants can obtain more information on the Fund’s tax reporting obligations on the website of the Dutch Revenue Commissioners. There are two different...
Sample 1
Confirmation and Signature. 21.1. The Agreement and the Data Processing Agreement enclosed as Appendix 1 are hereby confirmed by the Parties by the use of digital signature. The signers of the Agreement declare that they are authorised signatories in pursuance of the respective signing powers and rules on the right to make transactions. The printable and readable evidence of the signatures will appear from the last page of the finished document which will be submitted to all parties when all parties have signed. APPENDIX 1 TO TRADING AND DATA PROCESSING AGREEMENT BETWEEN PENNEO APS (Data Processor) AND CUSTOMER NAME (Data Controller) DATA PROCESSING AGREEMENT
Sample 1
Confirmation and Signature. I have read and understand the facility usage guidelines as stated above. As the person taking responsibility for the Little Snake River Museum facilities on the dates agreed upon with the LSR Museum. I agree to abide by the conditions put forth. Please return a signed copy of this agreement with your deposit check post-dated for a week prior to your event. Event type Date of event Time of event Start and Finish Number of guests Number of children Area of museum desired. Will alcohol be served? Board approval required Name (please print) Person responsible for event Phone Number: Signature: Date: Deposit amount $200- Received on: LSR Museum Employee Signature Please return this portion to the museum LSR Museum ALCOHOL POLICY: • A T.I.P.S. trained person must be dispensing for parties in excess of 50 people. • Name of Tips Trained person . • Liquor for an event is limited to beer and wine unless special permission is granted by the board. • Event hosts are expected to moderate the alcohol consumption and behavior of their guests. • No alcohol allowed in exhibit buildings without special permission. • Canned or boxed beverages are preferred. Responsible party: I take responsibility for any actions generated by my guests while at the museum. Signature:
Sample 1

Related to Confirmation and Signature

  • Required Signatures a. Curriculum Academic Xxxx(s) b. Curriculum Chair(s)

  • Counterparts and Signatures The Agreement may be executed in multiple counterparts, each of which shall be deemed an original, but all of which taken together shall constitute one and the same instrument. A Party may evidence its execution and delivery of the Agreement by transmission of a signed copy of the Agreement via facsimile or email. In such event, the Party shall promptly provide the original signature page(s) to the other Party.

  • Authorized Signatures (1) Each of the undersigned represents that he or she is fully authorized to enter into the terms and conditions of, and to execute, this Settlement Agreement on behalf of the Parties identified above their respective signatures and their law firms.

  • Authorized Signatories The parties each represent and warrant to the other that (1) the persons signing this lease are authorized signatories for the entities represented, and (2) no further approvals, actions or ratifications are needed for the full enforceability of this Lease against it; each party indemnifies and holds the other harmless against any breach of the foregoing representation and warranty.

  • Witness Signature 4. PARENT/GUARDIAN CONSENT: (for applicants under 18 years) – I hereby certify and decree that all the information contained in the declarations above is true and accurate Print Name:................................................................... Signature …………………………………………....……... Relationship to applicant ……………………………… Phone Contact ……………………................................... Address …………………………………………………………………….....................................................................

  • Authorized Signature Your signature on the Account Card authorizes your account access. We will not be liable for refusing to honor any item or instruction if we believe the signature is not genuine. If you have authorized the use of a facsimile signature, we may honor any check or draft that appears to bear your facsimile signature even if it was made by an unauthorized person. You authorize us to honor transactions initiated by a third person to whom you have given your account number even if you do not authorize a particular transaction.

  • Student Signature By signing this contract, Resident agrees to pay the contract amount (room, board and association fees) in accordance with Addendum B: Rate and Payment Schedule. Resident may pay the full amount due prior to the due date, at the Resident’s election.

  • EFFECTIVE DATE AND SIGNATURE This MOU shall be effective upon the signature of authorized officials from Party A and Party B. It shall be in force from (Date to be finalized with Lease-Up) to (Date to be finalized with Lease-Up). Parties A and B indicate agreement with this MOU by their signatures below. Party A Party B By: By: Title: Title: Signed: Signed: Date: Date:

  • AGREEMENT SIGNATURES By signing below, both parties agree to the terms and conditions of this Agreement. Please acknowledge acceptance of this document and terms by returning a signed copy within seven (7) days of issuing. If a signed copy is not returned within seven (7) days and you are attending service, Fighting Chance will deem this to be acceptance of the document. If signed by Xxx XxxXxxxxxxX: Signature of Participant: Date: If signed by Person Responsible: I confirm that this Agreement has been explained to the individual receiving the services and that they agree to the terms. I further confirm that I have authority to sign on their behalf. Signature of Person Responsible: Date: SignaĒure on behalf of FighĒing Chance: Signature of Person(s) responsible: Date: Name: Appendix 1 Key Contact Details Participant’s Name Participant’s Email Participant’s Phone Participant’s Address Person(s) responsible’s Name Person(s) responsible Relationship to Participant Person(s) responsible’s Email Person(s) responsible’s Phone Support Coordinator (where applicable) Support Coordinator’s Name Support Coordinator’s Email Support Coordinator’s Phone Shared Living/Supported Accommodation/Group Home (if applicable) House Manager’s Name House Manager’s Email House Manager’s Phone Additional Contacts (if applicable) Role Contact’s Name Contact’s Email Contact’s Phone Appendix 2 NDIS Claiming Preferences Fighting Chance supports NDIS participants who are NDIA-Managed, Self-Managed or Plan Managed. To invoice and bill you correctly, it is important you keep us updated with your plan management preferences, and let us know ongoing if your status changes. For the purposes of services delivered by Fighting Chance, your NDIS plan is: (please tick) ☐ NDIA-MANAGED You understand that Fighting Chance will claim directly through the NDIA portal if your funding for Fighting Chance is NDIA-managed, so you will not receive any direct request for payment from us. To ensure that you do not get a text from the NDIA to approve each claim weekly, endorse Fighting Chance as a ‘My Provider’ for automatic payment processing. Instructions can be found at xxxxxxxxxxxxx.xxx.xx/xxxx/ or you can contact the Fighting Chance My Provider Endorsement Helpdesk on (00) 0000 0000 or xxxxxxxxxxxxxxx@xxxxxxxxxxxxx.xxx.xx ☐ (Optional) Please supply me, by email, with monthly Statements of Account to: ☐ SELF-MANAGED ☐ I am self-managed and would like to be invoiced for services once a week. Please email invoices to: Please see Appendix 3 for Self-Management Payment Options. ☐ PLAN-MANAGED Please send invoices to my plan manager: Plan management organisatio Contact Name Email Address Phone number ☐ OTHER FUNDING (eg. self-funded, iCare or other insurance funding) Please email invoices to: Appendix 3 Self-Managed Payment Options Participants who are self-managed have a number of payment options with Fighting Chance: ☐ DIRECT DEPOSIT (preferred option) Payment of Fighting Chance invoices can be made by Electronic Funds Transfer (EFT) through your bank. Fighting Chance’s bank account details are as follows: Bank: Commonwealth Bank of Australia Account Name: Fighting Chance Australia Ltd BSB: 062-438 Account Number: 00000000 To ensure all payments are correctly allocated to your account, please include the full invoice number in the reference field. ☐ CREDIT CARD Payments can be made by credit card by clicking the ‘pay by credit card’ link included on the invoice. Please note that a service fee for this option will be imposed. ☐ PAYPAL Payment of your invoices can also be made via our PayPal account. To make payment via PayPal, please access the following link: xxxxx://xxxxxx.xx/FightingChanceAus?locale.x=en_AU To ensure your payment is correctly allocated, please enter the full invoice number in the reference field. Appendix 4 Non Face to Face Time Breakdown - Jigsaw Standard Non Face-to-Face Supports Delivered to every Jigsaw Participant daily, weekly, annually Writing the Board (i.e. preparing and writing up each person’s individualised program for the following day). Reviewing Trainee records/journal notes/medical or other key information to be able to best support the person during their day. Parent/Guardian/Carer Updates, i.e. emails, phone calls. Pre- and post-shift sta briefings. Zone setup (setting up workstations, boxes, visuals and group training areas) Resource development to support each Trainee to progress towards their employment goals (adapting training resources, creating visual aids and cheat sheets, etc). Research/Coordination to implement support strategies (disability, behavioural and learning strategies). Family reviews and the development of training plans (planning, delivery and follow up). Planning social events and extra curricular training (e.g. TAFE). Standard NDIS Annual Support Review Letter. Standard Ǫuarterly Reports - Upon Request. Complex Non Face-to-Face Supports - Delivered to Jigsaw Participants with High Intensity Support Needs (in addition to supports outlined in Standard) Allied health meetings, phone calls, correspondence. Specialist/additional sta training (internal or external), i.e. BSP implementation training. Creation of additional/detailed social stories/visuals. Data collection requested by behaviour therapists. Incident follow up or crisis meetings (seperate to regular family updates or regular allied health meetings). Development/review/discussion of medication forms/transfer plans/mealtime assistance plans etc. Detailed and regular sta training on individual complex behaviour/medical/transfer/mealtime support plans. Extended daily pre-brief and debrief. Additional Non Face-to-Face Supports - billed separately upon request Detailed NDIS Review Letters One-o engagement or training with Allied Health. Detailed Ǫuarterly Reports.

  • Counterpart Signature This Agreement may be signed in counterpart, and the signed copies will, when attached, constitute an original Agreement.

Draft better contracts in just 5 minutes Get the weekly Law Insider newsletter packed with expert videos, webinars, ebooks, and more!